Pediatricians Quit Clinic on Short Notice
CEO: 'We'll be Fine’

By Dave Adalian

Tulare - Three members of Tulare Pediatric Group sent Tulare Community Health Clinic officials scrambling when they gave two-day notice last week they would no longer see patients at the federally qualified clinic.

While clinic Chief Executive Officer Graciela Soto-Perez was upset about the short notice, she said she wanted to assure patients the clinic would operate as usual.
“We did lose four wonderful pediatricians [a fourth member of the practice gave 30-day notice], but I want to assure the patients we will continue to provide services,” Soto-Perez said late last week. “We'll be OK, we'll be fine.”

Family practitioners, two physician assistants, a Farmersville pediatrician and Dr. Robert Orth, who gave the 30-day notice, will be seeing the children while the clinic recruits for three pediatricians, she said. “It's difficult to recruit, so it will take awhile.”

While children will continue to be seen in Tulare, Soto-Perez said the clinic will have to send those needing hospital care to Kaweah Delta Medical Center in Visalia until new pediatricians are hired. The clinic has worked out an agreement with Sequoia Pediatric Group in Visalia to provide for them while they are patients at Kaweah.

Meanwhile Tulare Pediatrics, the only pediatric group in Tulare, opened a satellite pediatrics clinic Monday at 1008 Cherry St. under the auspices of Tulare County Health and Human Services.

Strained Relationship

Dr. Prem Kamboj and his pediatric group have had a strained relationship with Tulare Community's management for more than two years, so the group's departure was not a surprise—only the timing.

“We knew for a long time that the pediatric group was unhappy,” board President Steven Holdridge said. “However, we felt that when the time came that they moved on they would have given us 30-day notice as our contracts specify. We do feel they owed it to our patients to give us a 30-day notice.”

Kamboj and the firm's legal counsel said three of the four physicians in his group were under no obligation to provide the 30-day notice because they had been working without a contract since June.

“How can they ask us to give notice when they could tell you tomorrow, 'don't come? You have no contract,'” Kamboj said.

He said the group always has seen Medi-Cal patients and its only commitment is to the patients. “Now we're going to see them at our facility.”

He also said the doctors would have extended their stay a couple weeks had clinic officials asked.

The decision to leave the clinic was a difficult one, Kamboj said. “It took us 18 months to take this step,” he said, reporting that is how long the county had been requesting the group to open a satellite clinic here.

He had balked at the idea despite on-going friction with the clinic, because he had helped start the clinic in March 1995 and was “passionate” about it and did not want to hurt it, he said, adding he left the final decision of whether to leave to the other group members.

At the Heart

Clinic officials and the doctors disagree as to what was at heart of the pediatric group's decision to leave.

“It's all about the money,” Soto-Perez said, reporting the doctors did not have a contract because they wanted a raise from the current $35.71 per patient visit to no less than $55 per visit.

But the clinic, after months of working with the budget, decided it could only offer doctors $40 per visit, she said. “They wanted money I couldn't afford and I'm not going to put the clinic at risk.”

Kamboj denied money was at the heart of the issue and said he would not comment further other than to say that when the clinic started in 1995, it was paying doctors $40 per visit. “When it started losing money, I was the medical director and I suggested we take a pay cut…and it never went back up,” he said. “If it were money, why would I lean on my physicians and friends in 1996 or '97 to take a voluntary pay cut?”

The clinic started the physicians at a high rate when it first opened and the $40 the clinic is now offering physicians is still competitive, Holdridge said. Kamboj disagreed, reporting Kaweah Delta pays its clinic doctors $62 a visit.

'Lack of Trust'

According to Kamboj, the real issues were the “unprofessional way” the clinic treats its physicians, a “lack of trust” generated in large part by the continued involvement of former board member Bob Montion—which Soto-Perez denies—and the overall feeling of group members the clinic did not want them to work there.

Dr. Robert Orth, the group member who is working at the clinic until Aug. 29 because his contract has not expired, said he has worked at many clinics where the relationship between doctors and administrators was “just great,” but that is not the case here.

“It seems whenever we try to work with the administration to make things better—with scheduling and things like that—we always seem to find resistance to our suggestions,” Orth said.

Orth said at one point he was criticized for not seeing enough patients and then, three to four months later, for seeing too many.

“And they're the ones doing the scheduling,” he said. “They just seem to want to complain. I have never experienced this with any clinic.”

Kamboj and Orth said it took their group more than six months to convince the clinic its patient visit numbers—which determine not only physician pay but clinic reimbursements—were off and when it happened a second time, it took three or four months to resolve.

Montion Issue

The issue regarding Montion has been on-going.

Soto-Perez confirmed the board put Kamboj on a month-to-month contract the year before last as warning to “stop hurting the clinic,” because he had complained-unsuccessfully, she said — to federal authorities about what he saw as a conflict of interest by a board member.

That board member was Montion, who oversaw Soto-Perez's work as a USC graduate student when she was assigned to Tulare District Hospital and who also served on the Tulare Community board before he resigned.

During his successful bid to win a seat on the Tulare Local HealthCare District board two years ago, Kamboj spoke publicly about his concerns about Montion's involvement with the clinic while still employed by the hospital. He said it was not appropriate.

And although he resigned from the clinic board last year, Kamboj alleges Montion continues to be involved with the clinic.

“What kind of comfort level does it give me when I see him sitting with Graciela for two or three hours,” he said.

“I can assure you, I never had a three-hour conversation with Bob,” Soto-Perez said. “I don't have the time.”

She also said that when Montion was on the board, he defended and was very protective of Kamboj. “He use to tell me to give Dr. Kamboj what he wanted and I would refuse,” she said. “It wasn't Bob. It was me. Bob was actually supporting him.”

Holdridge said it is true Soto-Perez has little contact with Montion since his resignation.

“We feel this is an on-going feud between Montion and Kamboj and the clinic unfortunately is suffering from it,” he said.

Montion said he has occasional contact with Soto-Perez and that is only to inquire about one of her children who has spinal bifida as he does.

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Former CEO Running for TDH Board Seat
Sherrie Bell also Seeking Election

Tulare - Bob Montion said his health prevents him from ever serving again as a chief executive officer, but he very much wants to serve on the board of the Tulare Local HealthCare District, where he was the top administrator for 10 years.

Montion maintains he can work with the current board despite past conflicts with board Chairman Dr. Parmod Kumar and despite an unresolved lawsuit the hospital has filed that charges him with breaching terms of his severance agreement and waging a “mean-spirited vendetta” against the district. He resigned in March 2007 for health reasons.

“I truly believe when you boil down the lawsuit by the hospital against me, it's a misunderstanding—a monumental miscommunication and misunderstanding,” Montion said.

The 51-year-old former hospital CEO is one of two people who, as of late Monday morning, have become official candidates in the race to fill three seats. Incumbent Roger McPhetridge has said he will seek re-election, but incumbent Deanne Martin-Soares has said she will not. Kumar has not announced his intentions.

The other official candidate is 48-year-old Sherrie Bell, a part-time real estate agent and community volunteer, who said her experience, also includes obtaining a degree in business education and running a word-processing, medical transcription business in the Bay area years ago to put her husband through dental school.

“My strength is my fiscal background, but also I really love Tulare,” Bell said. “I feel like we have a wonderful school district, we have a wonderful city government and we have the possibility of a wonderful hospital, but we haven't achieved that yet.”
People are “very happy” with the new hospital administration and now is the time to bring the hospital up to a higher level that will instill public confidence, Bell said.

“Budget issues need to be looked at,” she said, explaining she knows the $85 million bond voters approved will not be enough to cover the hospital expansion cost. She said she does not support going back to the public for another bond election and wants to, instead, “find a grant or some other means to raise the money.”

Her election would also give the board a balance it now lacks with three doctors and two nurses serving as directors, Bell said. “I'm someone with more of a business background versus medical.”

She described herself as having “good people skills and a good head on my shoulders. I think that listening to people and making judgments according to information are my strengths.”

In addition to working in real-estate, she is president of the Tulare Noon Rotary Club. The mother of six children also has volunteered many years in classrooms and has been involved with the local American Youth Soccer Organization and Boy Scouts.

In the early 1990s, Bell also served on a citizens committee charged with studying the possibility of creating election districts for the school boards, City Council and other elected bodies.

'Examination of Conscience’

Montion said he went through an “examination of conscience” before deciding whether to run and concluded he has a lot to offer even though he is “resigned to the fact” he'll never be a CEO again. “I love the hospital, I love the people, I love what I did.”

Measure D, which authorized an $85 million bond sale for a new hospital tower, “has a lot to do with me running for the board,” he said.

He promised voters “a first-class hospital” and “that promise didn't end with my last paycheck,” he said. “I want to be there and see that my promise is kept.”

He also said he is “uniquely qualified” to serve on the board because of his 30 years in hospital administration. “I was the ranking CEO in the Valley when I left,” he said.
The new CEO, Shawn Bolouki, and his staff “are going to need the kind of support and understanding of issues that I bring to the table,” he said. “I say that with all sincerity. I stand there to support and advise as an elder statesman, because I physically could never run a hospital again. Mentally, I don't ever want to run a hospital again.”

Asked if he could work with Kumar and the two newest board members—Drs. Prem Kamboj and Lonnie Smith—who allowed an interim administration to dismiss several of his key appointees after he retired, Montion said he could.

“I think it's time for everybody to get back to who we were and how we worked,” Montion said, adding during most of the years he was CEO he and the doctors worked well together.

“Dr. Kumar referred to me as 'brother' for eight or nine years” and Kamboj was “the only doctor I had a regular luncheon engagement with and I relied on his counsel,” he said. “Lonnie Smith was one of the people who toasted me at my 50th birthday.”

Despite Montion's comments, at least one of the doctors—Kamboj—still has issues with Montion, although they appear related to the Tulare Community Health Clinic.

If Martin-Soares holds to her announced decision not to run or Kumar decides not to run, the filing period for the hospital board race will be extended until Wednesday.

McPhetridge said last week, he definitely will run. “There's still a lot to do and I think, as a board, we've come together and we're headed in the right direction,” he said.

Other Races

As of Monday morning:

• Tulare City Council: Incumbents Phil Vandegrift, Craig Vejvoda and Carlton Jones have each taken out re-election papers, but only Vandegrift has returned his. Challenger Wayne Ross, owner of Ross Wealth Management, has taken out papers. The filing deadline is Friday, unless Vejvoda or Jones does not file his papers.

• Tulare Joint Union High School District: Elva Jean Strawn, a retired health technician, Carlos Carrillo, a teacher in the Tulare City School District, and Samantha Cushing, have qualified to run for the high school board. Cathy Mederos, a parent and community volunteer, has taken out papers. None of the two incumbents are running in the race, so the filing deadline is extended until Wednesday.

• Tulare City School District: No challengers have emerged in the elementary school board race, where incumbents Melissa Janes, Teresa Garcia and Willard Epps are seeking re-election and have qualified for the ballot. The filing period ends Friday.

• Tulare Memorial District: Incumbents James D. Pidgeon, Filbert Bejarano and Phil Vandegrift are seeking re-election. No challengers have filed. The filing deadline is Friday.

• College of the Sequoias, Ward 4: Incumbent Lori Sousa Cardoza will seek re-election. No challengers have emerged. The filing deadline is Friday.

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New School to Develop,
Train Christian Artists

Tulare - For almost seven years Martin Mora has worked to build a strong music ministry at Tulare's Sunrise Community Church and by all accounts has enjoyed great success.

“He's an outstanding musician and a teacher nonpareil, especially with younger children,” said businessman Scot Hillman, who is also a musician and plays in his church's band.

The need for more church musicians and worship leaders is felt in almost every church in the area, Hillman said, explaining why he and others are supporting the effort of Mora and nine other teachers from various Tulare churches who will open the Fusion School of Music in September.

“I'd sure like to see a new generation of musicians,” Hillman said. “We need more people in the pipeline.”

The school anticipates 100 students will enroll during the fall registration period, which will run from August 18 to September 5.

Housed at Sunrise Community, which is in new quarters at 100 East Inyo Ave., the school will offer a wide-array of individual and group classes for both youths and adults and scholarships will be offered for those who cannot afford them.

Initially the school expects to teach students to play instruments common to praise and music, including piano, keyboard, acoustic and electric guitar, bass, drums and percussion. Vocal lessons also will be offered. Instruction in sound reinforcement skills, worship team leadership a Latin worship for missionaries also will be offered this fall.

Mora said much thought went into naming the new music school.

'Mixing' Backgrounds

“Fusion means 'mixing' and what we're trying to do is mix different cultures and economic backgrounds for one purpose — to make a difference by making music, different styles of music,” he said, noting later the effort also involves different denominations.

He noted Fusion is spelled the same way in English and Spanish, although the pronunciation differs.

For the past four years Mora has taken the youngsters from his church to an orphanage in Tijuana to share their musical gifts by teaching other children and that opportunity will now be extended to children in the music academy, he said.
They also will be invited to participate in a summer concert — a night of music, fun and food — that Sunrise holds each year and to participate in the city's annual Children's Christmas Parade.

Mora, who was born in Costa Rica and began playing music in a church band at age 13, played guitar professional for 10 years in a salsa band and has worked in the recording and production end of the music industry. He has a music degree from Universidad de Costa Rica.

He moved to California when the music company that employed him transferred him to Southern California to produce music for its Spanish-language record label, he said.

Four years later he realized God had something different in store for him.

'Stirred My Heart'

“He stirred my heart into a deeper commitment,” he said.

During his music ministry career in California, Mora worked at Calvary Chapel and at Saddleback Church with Rick Warren, author of “The Purpose Driven Life.” Prior to coming to Tulare, he was an organist at the Crystal Cathedral.

All these churches were mono-lingual and Mora said he could not help but pray: “God, it will be really cool if I can find a place where I can combine all that I have learned.”

Only a few months later, he learned the Rev. Russ Siders, pastor of Sunrise Community, was looking for a bi-lingual music minister and a friend said to him, “Martin, maybe this is the answer to your prayer.”

He has served for eight years at Sunrise Community and lives in Tulare with his wife, Flory, and their three children.

Besides Martin Mora, others who will teach at Fusion are: Melissa Roark, Matias Mora (Martin's son) and Amanda Oliver, all of Sunrise Community; Daniel Elias and Dave Ribeiro from First Baptist Church; Paul Serpa; Jaclyn Visser and Lani Gorzeman of Tulare Community Church; and Steve Walker of Vineyard Christian Fellowship.

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Attorneys Want Settlement
Enforced in Hospital Case

Tulare - Attorneys for the Tulare hospital district and former Chief Financial Officer Lucy Reimche will ask a Tulare County Superior Court judge to enforce a settlement agreement and arbitration award of $600,000 in the case.

Shelley G. Bryant, Reimche's Fresno attorney who has already filed a motion with the court, and the Tulare Local HealthCare District's counsel, Dennis G. McCarthy of Monterey, said last week he also plans to file an enforcement petition.

Because McCarthy said his version will differ from Bryant's, Judge Lloyd Hicks will have to decide on Aug. 28 which one, if either, to enforce.

Mediation in January resulted in an agreement signed by all parties with the understanding a formal version would be prepared and signed. Disagreement arose as to wording of the final document, which Reimche has contended would prohibit her from cooperating with any federal investigation of what she alleges were unlawful Medicare billing practices. The hospital district contends the settlement does not do that.

Reimche has made a number of allegations, including wrongful termination, sexual harassment, retaliation, defamation and labor code violations, in connection with her November 2006 dismissal by the hospital district board.

The hospital district has denied the allegations. An investigator hired by the hospital board reported during a public hearing that Reimche's dismissal stemmed from her inability to work with others.

Bryant also has filed a motion asking to be relieved as Reimche's attorney, charging his client has refused to follow his advice to settle the case.

That motion will be heard Sept. 9, if a settlement is not enforced, and a new trial date will be set.

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New Facility Adds to Firefighters' Training

Tulare - Should a building or trench collapse and trap people in Tulare or Kings counties or should a rescue involve a silo or other tall structure, Tulare city firefighters, because of their specialized training, will likely be called to the rescue.
In a move to become even more proficient in above ground rescues, the Fire Department has just completed a tower addition to the Tulare City Fire Training Facility behind Station 1 on South Blackstone Street.

The expansion will enable the department to conduct the training necessary to create a state-certified urban search and rescue team, Fire Training Capt. Steve Facchini said.

“Once we get the team together, we'll be the medium duty team in the county,” Facchini said.

The department has another goal as well.

“We're trying to get the state to certify us as a medium duty urban search and rescue training site,” Fire Chief Michael Threlkeld said. Facchini said the three-story structure is made from five seatrains and was the idea of Battalion Chief John Binaski. The department paid about $50,000 for the addition, much less than training towers built with more traditional materials, he said.

The engineering work for the metal stairways was donated, as were some other materials. There are only a couple of buildings in town with more stories.
The tower addition allows firefighters to learn how to do search and rescues in dark buildings, working with ladders and ropes. For realism, smoke and even fire can be added to the metal structure, which will not burn.

Outside the structure are huge blocks of cement, so firefighters can train to move heavy objects by hand, and cement piping so they can practice breaking through walls or materials when in a confined space.

Fourteen members of the Fire Department have had training in medium duty urban search and rescue and are certified at levels one and two. The new structure will allow them to become certified at levels three and four.

Threlkeld said the department will make the facility available to the Tulare Police Department and other public service agencies for training.

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